Jane Dotson
Billing Arestin to medical insurance can be a tricky process. Arestin is indicated as an adjunct to scaling and root planing (SRP) procedures for the reduction of pocket depth in patients with adult periodontitis. It may be covered under your medical insurance plan's prescription benefits, but this varies depending on the insurance provider and the specific plan. If you receive a bill, the first step is to check if the bill contains the words insurance pending or any other indication that the bill has been submitted to the insurance company. If it hasn't, you can call the hospital or doctor and ask them to bill your insurance company, providing them with your insurance information. If you don't have insurance coverage for Arestin, there are other options to explore, such as payment plans or co-pay assistance programs offered by the dental office or Arestin manufacturers.
| Characteristics | Values |
|---|---|
| Who handles the billing? | Your dental office handles the paperwork to find out if your medical plan may cover Arestin. |
| Cost | The maximum benefit available is $1,500 per prescription fill. You are responsible for all additional costs and expenses after the maximum benefit is reached. |
| Co-pay | If your medical insurance provides coverage for Arestin, you may be eligible for a co-pay as low as $0. |
| Insurance coverage | Arestin is not covered by federal, state, or other governmental programs, including Medicare, Medicaid, TRICARE, Veterans Administration, or Department of Defense health coverage. |
| Prescription | You must sign a prescription form before leaving the office. |
| Eligibility | Commercially insured patients may be eligible for a copay as low as $0 through the Arestin Copay Assistance Program. |
| In-network coverage | If you use most types of health insurance, you may be eligible for 90 days of in-network coverage after your provider leaves the plan’s network. |
| Emergency care | If your health insurance covers emergency care, you can't be charged more for emergency medical services than the in-network “cost-sharing” rate. |
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What You'll Learn
Check if your medical insurance covers Arestin
If you already have dental insurance, ask your dental office or plan if there is coverage for Arestin. You may also qualify for coverage under your medical insurance plan's prescription benefits. Your dental office handles the paperwork to find out if your medical plan may cover Arestin.
To check if your medical insurance covers Arestin, you can take the following steps:
- Contact your health insurance provider's Member Services team. The phone number is usually on the back of your insurance ID card. They can tell you whether a prescription is covered and how much your insurance will pay.
- Ask your insurance company for a copy of your plan's Summary of Benefits and Coverage (SBC). This document lists the services the plan covers and how much.
- Use your plan's cost estimation tools to estimate what you might pay out of pocket for a certain service at a certain location.
- Review your plan's formulary (drug list). If your plan includes prescription drug coverage, it will have a list of the medicines it covers. Check if Arestin is included and if it needs any special approvals.
- If you receive coverage through a health savings account (HSA) or similar arrangement, understand how claims are processed and that amounts paid by a third party for your Arestin prescription may be deducted from your benefits limit automatically.
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Contact your insurance company
If you want to know whether your medical insurance covers ARESTIN, you should contact your insurance company or health plan. If you have health insurance through an employer, the federal Health Insurance Marketplace, a State-based Marketplace, or other individual market coverage, you are protected from "surprise bills" for emergency medical services. If your health insurance covers emergency care, you can't be charged more for emergency medical services than the in-network "cost-sharing" rate. However, some health plans do not cover emergency care, so it is important to check with your insurance company.
If you receive coverage through a health savings account (HSA) or similar arrangement, it is your responsibility to understand how claims are processed and that amounts paid by a third party for your ARESTIN prescription may be deducted from your benefits limit automatically.
If you are unsure about whether your insurance covers ARESTIN, you can ask your dental office to handle the paperwork to find out. If you do not have dental insurance, you may still qualify for coverage under your medical insurance plan's prescription benefits.
If you have insurance coverage for ARESTIN, you may be eligible for a co-pay as low as $0. ARESTIN Rx Access is available for eligible commercially insured patients, who may be able to receive ARESTIN through their medical prescription benefits.
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Ask your dental office about payment options
If you have health insurance, it is important to understand your plan and what is covered. Contact your insurance company or health plan if you are unsure about what your plan covers. In the case of ARESTIN, a prescription medication, your insurance may cover it under your plan's prescription benefits.
If you are unsure about whether your medical insurance covers ARESTIN, your dental office can handle the paperwork to find out. They may suggest payment options that you are not aware of. For example, ARESTIN Rx Access offers eligible commercially insured patients the opportunity to receive ARESTIN through their prescription benefits, with a co-pay as low as $0.
If your insurance does not cover ARESTIN, you can discuss other options with your dental office that might make paying for your prescription easier. For example, you may be eligible for a co-pay as low as $0 through the ARESTIN Copay Assistance Program.
It is important to note that ARESTIN offers are not valid for individuals eligible for reimbursement of prescriptions by governmental programs, such as Medicare, Medicaid, or the Veterans Administration. Additionally, ARESTIN offers cannot be redeemed at government-subsidized clinics.
If you receive a bill that does not indicate that it has been submitted to your insurance company, you can call the doctor or hospital and ask them to do so. If they refuse or it is not possible, you may need to fill out a reimbursement form and submit it to your insurance company.
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Find out if you are eligible for a co-pay
If you have medical insurance, your dental office will handle the paperwork to find out if your plan may cover ARESTIN. If your insurance does provide coverage for ARESTIN, you may be eligible for a co-pay as low as $0.
If you don't have insurance coverage for ARESTIN, you can discuss other options with your dental office. They may suggest payment options you are not aware of, and you may still be eligible for a co-pay as low as $0.
It's important to note that this offer is only valid for patients with private commercial insurance, where ARESTIN (minocycline HCI) microspheres, 1 mg is a covered medication. This offer is not valid for any person eligible for reimbursement of prescriptions in whole or in part by any federal, state, or other governmental programs, including Medicare, Medicaid, TRICARE, Veterans Administration, and others.
Additionally, this offer cannot be redeemed at government-subsidized clinics and is only valid for one prescription fill of ARESTIN. The maximum benefit available is $1,500 per prescription fill, and you are responsible for all additional costs and expenses after the maximum benefit is reached.
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Understand your rights with insurance
To bill Arestin to medical insurance, you must first check if your insurance provider covers Arestin. If they do, you may be eligible for a co-pay as low as $0. If your insurance does not cover Arestin, you can discuss other payment options with your dental office.
In the United States, patients have a set of rights that protect them and ensure they receive quality care. These rights include:
- The right to receive accurate and easily understood information about health plans, professionals, and facilities to help make informed decisions. This includes information on benefits, customer satisfaction, delivery systems, health plan operating procedures, and review rights.
- The right to a choice of healthcare providers to ensure access to appropriate, high-quality healthcare.
- The right to informed consent, which may vary from state to state.
- The right to confidentiality, which was federally protected under the Healthcare Quality Improvement Act of 1986 and the Health Insurance Portability and Accountability Act of 1996. Patients have the right to view their medical records, with some exceptions.
- The right to not be discriminated against in medical care and to have health information privacy, as enforced by the US Department of Health and Human Services' Office for Civil Rights (OCR).
- The right to access many types of preventive healthcare services without a fee-for-service, as outlined in the Patient Protection and Affordable Care Act (ACA).
- The right to make decisions regarding your body, as established in the 1900s when judges used property law precedents to declare that patients' rights to their bodies superseded physicians' decisions.
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Frequently asked questions
If you receive a bill from a hospital or doctor, first check that it does not contain the words "insurance pending" or any other indication that the doctor or hospital has submitted the bill to the insurance company. If it does not, call the doctor or hospital and ask them to bill your insurance company. You can provide them with the information on your insurance card.
If your insurance company does not cover Arestin, you may be able to discuss other payment options with your dental office. You may also be eligible for a co-pay as low as $0 through the ARESTIN Copay Assistance Program.
Federal law protects you from out-of-network bills for emergency services in hospitals and independent, freestanding emergency departments. If you receive a surprise bill, you can submit a complaint by calling the No Surprises Help Desk at 1-800-985-3059.
This offer is not valid for any person eligible for reimbursement of prescriptions by any federal, state, or other government programs, including Medicare, Medicaid, TRICARE, and the Veterans Administration.
